Stimulant Medication Use in Congenital Heart Disease

Children with congenital heart disease (CHD) are at risk for neurodevelopmental problems including attention-deficit hyperactivity
disorder.[Vetter: 2008][Bass: 2004][Kirshbom: 2005] While there have been reports of sudden cardiac death (SCD) in children without CHD using psychostimulant medications, this
risk is no greater than that for SCD in the general population.[Perrin: 2008] There are no clinical studies suggesting that children with most forms of CHD are at risk for SCD while taking stimulant
medications. According to the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac
Defects Committee and the Council on Cardiovascular Nursing, it is reasonable to consider treatment of ADHD in patients with
corrected or uncorrected CHD that is stable unless the patient's pediatric cardiologist has specific concerns. The following
conditions are associated with an increased risk of SCD and while they do not contraindicate the use of stimulants, these
medications must be used with caution and close monitoring:[Keane: 2006]

History of an arrhythmia requiring cardiopulmonary resuscitation, direct current cardioversion or defibrillation, or overdrive
pacing

Previous aborted SCD

Other clinically significant arrhythmia not treated or controlled

QTc on ECG >0.46 seconds

Heart rate or blood pressure >2 SD above means for age

If any of the above conditions or arrhythmias are diagnosed during treatment, consideration should be given to discontinuation
of the stimulant medication until further testing and treatment can be achieved. If arrhythmias are treated and controlled,
on approval of a pediatric cardiologist, the patient may be restarted on medication.